Ayala-Marín Alelí M, Iguacel Isabel, Miguel-Etayo Pilar De, Moreno Luis A
Growth, Exercise, Nutrition and Development (GENUD) Research Group, Universidad de Zaragoza, Zaragoza, España.
Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, España.
Front Public Health. 2020 Aug 28;8:423. doi: 10.3389/fpubh.2020.00423. eCollection 2020.
Addressing social disadvantages that lead to obesity should be a public health priority. Obesity prevalence among children and adolescents has reached a plateau in countries with high income but it continues rising in low-income and middle-income countries. In high-income countries, an elevated prevalence of obesity is found among racial and ethnic minority groups and individuals from disadvantaged socioeconomic backgrounds. In addition to classic socioeconomic status (SES) factors, like income, parental education, and occupation, recent publications have linked parental social disadvantages, such as minimal social network, non-traditional family structure, migrant status and unemployment, with obesogenic behaviors and obesity among children. Socio-ecological models of obesity in children can explain the influence of classic SES factors, social disadvantages, culture, and genes on behaviors that could lead to obesity, contributing to the elevated prevalence of obesity. Obesity is a multifactorial disease in which multilevel interventions seem to be the most effective approach to prevent obesity in children, but previous meta-analyses have found that multilevel interventions had poor or inconsistent results. Despite these results, some multilevel interventions addressing specific disadvantaged social groups have shown beneficial effects on children's weight and energy balance-related behaviors, while other interventions have benefited children from both disadvantaged and non-disadvantaged backgrounds. Considering obesity as a worldwide problem, the World Health Organization, the European Commission, and the National Institutes of Health recommend the implementation of obesity prevention programs, but the implementation of such programs without taking into consideration social disadvantages may be an unsuccessful approach. Therefore, the present publication consists of a review of the pertinent literature related to social disadvantage and its consequences for behaviors that could lead to childhood obesity. In addition, we will discuss the relationship between social disadvantages and the socio-ecological model of obesity in children. Finally, we will summarize the relevant aspects of multilevel intervention programs aiming to prevent obesity in children and provide recommendations for future research and intervention approaches to improve weight status in children with social disadvantages.
解决导致肥胖的社会不利因素应成为公共卫生的优先事项。在高收入国家，儿童和青少年肥胖率已趋于平稳，但在低收入和中等收入国家仍在持续上升。在高收入国家，种族和少数民族群体以及社会经济背景不利的个人中肥胖率较高。除了收入、父母教育程度和职业等典型的社会经济地位（SES）因素外，最近的出版物还将父母的社会不利因素，如社交网络有限、非传统家庭结构、移民身份和失业，与儿童的致胖行为和肥胖联系起来。儿童肥胖的社会生态模型可以解释典型的SES因素、社会不利因素、文化和基因对可能导致肥胖的行为的影响，这导致了肥胖率的上升。肥胖是一种多因素疾病，多层次干预似乎是预防儿童肥胖最有效的方法，但之前的荟萃分析发现，多层次干预的效果不佳或不一致且结果参差不齐。尽管如此，一些针对特定弱势社会群体的多层次干预对儿童体重和与能量平衡相关的行为显示出有益效果，而其他干预措施则使来自弱势和非弱势背景的儿童都受益。考虑到肥胖是一个全球性问题，世界卫生组织、欧盟委员会和美国国立卫生研究院建议实施肥胖预防计划，但在不考虑社会不利因素的情况下实施此类计划可能不会成功。因此，本出版物包括对与社会不利因素及其对可能导致儿童肥胖的行为的影响相关的文献的综述。此外，我们将讨论社会不利因素与儿童肥胖社会生态模型之间的关系。最后，我们将总结旨在预防儿童肥胖的多层次干预计划的相关方面，并为未来的研究和干预方法提供建议，以改善处于社会不利地位儿童的体重状况。
